Provider First Line Business Practice Location Address:
1007 DANA DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96003-4036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-243-3550
Provider Business Practice Location Address Fax Number:
530-246-3123
Provider Enumeration Date:
10/14/2009